不同绒毛膜性三胎妊娠期待与减胎治疗的妊娠结局  

Pregnancy outcomes of expectant management and multifetal reduction in different chorionicity triplet pregnancies

作　　者：李根霞[1] 李孟宇 张俊雅 李娇 程春花[1] 谢明坤[1] 冯帆[2] 董理 Li Genxia;Li Mengyu;Zhang Junya;Li Jiao;Cheng Chunhua;Xie Mingkun;Feng Fan;Dong Li(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ultrasonography,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052

出　　处：《中华围产医学杂志》2024年第8期631-636,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨不同绒毛膜性三胎妊娠不同治疗方式的妊娠结局。方法回顾性纳入2017年1月1日至2023年11月30日在郑州大学第三附属医院产科就诊并分娩的97例三胎妊娠孕妇,根据绒毛膜性分为单绒毛膜三羊膜囊三胎(monochorionic triamniotic,MCTA)24例、双绒毛膜三羊膜囊三胎(dichorionic triamniotic,DCTA)33例和三绒毛膜三羊膜囊三胎(trichorionic triamniotic,TCTA)40例,根据治疗方式分为期待治疗组46例、减为双胎组40例和减为单胎组11例,比较各组的妊娠结局。采用t检验、校正t检验、单因素方差分析和LSD检验、Kruskal-Wallis检验和Mann-Whitney U检验、χ^(2)检验、连续校正χ^(2)检验、Fisher精确概率法及Bonferroni校正进行统计学分析。结果(1)相同绒毛膜性不同治疗方式妊娠结局比较:MCTA中,期待治疗组与减为单绒毛膜双羊膜囊双胎组(monochorionic diamniotic,MCDA)相比,分娩孕周、<37周活产分娩率、<32周活产分娩率、新生儿出生体重及严重并发症发生率差异均无统计学意义(P值均>0.05)。DCTA中,期待治疗组与减至单胎组相比,分娩孕周[(31.8±2.7)与(37.9±1.3)周,U=-3.66]和新生儿出生体重[(1604.3±422.6)与(2997.1±598.9)g,U=-3.84]均较低(P值均<0.05),<37周活产分娩率较高(9/10与1/8,Bonferroni校正,P<0.017)。期待治疗组妊娠并发症(5/10与2/15和0/8)和新生儿严重并发症发生率[37.0%(10/27)与10.7%(3/28)和0/7]有高于减为双绒毛膜双羊膜囊双胎(dichorionic diamniotic,DCDA)和减为单胎组的趋势,但两两比较差异均无统计学意义(P值均>0.017)。TCTA中,与期待治疗组相比,减为DCDA组分娩孕周更大[(37.1±0.9)与(34.1±2.7)周,t'=-4.36],新生儿出生体重增加[(2647.5±377.8)与(1902.5±459.9)g,t'=-6.98](P值均<0.05);母体妊娠并发症发生率[3/15与54.2%(13/24)]和<37周活产分娩率[3/15与66.7%(16/24)]降低(Fisher精确概率法,P值均<0.05)。(2)相同治疗方式不同绒毛膜性的妊娠结局比较:期待治�ObjectiveTo investigate the pregnancy outcomes of different treatment methods for triplet pregnancies with different chorionicities.MethodsA retrospective study was conducted on 97 triplet pregnancies who visited and delivered at the Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,from January 1,2017,to November 30,2023.The pregnancies were categorized based on chorionicity into monochorionic triamniotic(MCTA)(n=24),dichorionic triamniotic(DCTA)(n=33),and trichorionic triamniotic(TCTA)(n=40).They were further divided into expectant management group(n=46),reduction to twins group(n=40),and reduction to singleton group(n=11)based on the treatment method.Pregnancy outcomes were compared among the groups.Statistical analysis were performed using t-test,corrected t-test,one-way analysis of variance and LSD test,Kruskal-Wallis test and Mann-Whitney U test,Chi-square test,continuity correction Chi-square test,Fisher's exact test,and Bonferroni correction.Results(1)Comparison of pregnancy outcomes with different treatment methods for the same chorionicity:In MCTA,there were no statistically significant differences in gestational age at delivery,live birth rate before 37 weeks,live birth rate before 32 weeks,neonatal birth weight,and incidence of severe neonatal complications between the expectant management group and the reduction to monochorionic diamniotic(MCDA)group(all P>0.05).In DCTA,compared to the reduction to singleton group,the expectant management group had lower gestational age at delivery[(31.8±2.7)vs.(37.9±1.3)weeks,U=-3.66]and neonatal birth weight[(1604.3±422.6)vs.(2997.1±598.9)g,U=-3.84](both P<0.05),but higher live birth rate before 37 weeks(9/10 vs.1/8,Bonferroni correction,P<0.017).The expectant management group showed a trend towards higher rates of pregnancy complications(5/10 vs.2/15 and 0/8)and severe neonatal complications[37.0%(10/27)vs.10.7%(3/28)and 0/7]compared to the groups reduced to dichorionic diamniotic(DCDA)twins and singletons.However,the differences b

关 键 词：三胎妊娠 期待治疗 减胎 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]